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Eligibility / Coverage

All employees and their immediate family members are eligible. Immediate family members or

dependents are defined as anyone living in the employee’s household, including significant others and any dependents living outside of the home. Eligible employees include full time, part time, per diem and on-call employees.

You do not have to enroll for coverage. You and your eligible dependents are automatically covered on your date of hire.

Services Available

Services are available through APS Healthcare (APS).

● A plan of assistance which includes problem

assessment, education, information, and assistance with initial crisis management is provided. Such personal problems may include, but are not limited to, family or relationship problems, parenting difficulties, work related problems, substance use and abuse, grief and loss, emotional and physical abuse, and anxiety and depression. The plan of assistance may include a referral to an outside agency for further support or assistance. Fees incurred by any employee or family member at agencies other than APS are not included in the EAP coverage and are the full responsibility of the employee or eligible family member.

● Counseling sessions including an initial evaluation to identify problems, with follow- up contact as deemed appropriate by the counselor. APS agrees to provide a maximum of three (3) counseling sessions (hours) per incident per year for each eligible employee and their family members. APS shall determine what constitutes a separate incident. A

If session length is extended, the number of sessions is reduced to equal a maximum of counseling hours.

● APS shall make EAP masters or doctoral level consultants available telephonically 24 X 7. As appropriate, the EAP telephonic consultant will facilitate an in-person EAP assessment.

● Legal and Financial Resources: APS shall provide access for non employer-related legal issues via telephonic and face-to-face consultation by legal and financial specialists. Intake/requests for services shall be made via toll-free number through an APS EAP counselor. Services shall include:

● Free 30 minute telephonic or face-to-face consultation with local attorney. Topics of assistance include, among others: civil/ consumer issues, personal/family issues, financial matters, real estate, criminal matters, IRS issues, consumer credit services, and estate planning. Twenty-five percent (25%) reduction in fees if network attorney is retained.

● Free 30-minute telephone consultation with a financial representative for the following issues, among others: retirement planning, college funding, life insurance needs, charitable giving, deferred compensation, or debt. Consultations are provided at no cost to the employee or household member by certified and/or licensed, as applicable, financial organizations or independent agents. Following consultation, any

services purchased from the organization or agent, if any, would be the responsibility of the employee or household member.

● Upon Employer request, APS shall coordinate Critical Incident Stress Debriefing (CISD) services in the event Employer suffers a catastrophic event, including but not limited to violence in the workplace, injury or death of an employee,

per year are included in the contracted rate with additional hours available on a fee for service basis.

● Management Consultation Services are available to Employers Managers, Supervisors and Human Resource professionals for issues impacting the overall well-being of the workplace included but not limited to, performance problems, an employee’s personal problems, team building and communication problems.

● Helping Hands Fund Program is coordinated through APS. The program provides financial assistance to employees who are experiencing financial emergencies. The following services will be offered for Marionwood and Providence Regional Services.

● When an employee calls APS to access the Helping Hands Fund, an EAP consultant will complete a full clinical assessment.

● APS will email or fax the Helping Hands Fund Application to the employee who will return the completed application and any documentation that supports the hardship back to APS.

● The Lead EAP Consultant will contact the employee to complete the Helping Hands Score Sheet and complete the financial assessment / evaluation.

● At the completion of the session, APS will present recommendations to an approved Providence Health & Services representative who will make the final decision on the approval of the grant request.

● APS will be notified within one week of the Providence Health & Services decision and APS will notify the employee with the determination.

Accessing Services

Accessing On-Line EAP Resources

If you choose to research issues or get help using the Internet, you can access APS HelpLink the online resource available through the EAP at www. apshelplink.com. The site provides information on a variety of topics such as mental health and substance abuse, child and elder care referrals and more. You can access the site 24 hours a day, seven days a week. Much of the information on the site is also available in Spanish.

The APS web site also provides quick links to the following tools in the right navigation, click on: ● Locate Resources to find help in your area, for

example, to locate available day care, schools and volunteer opportunities.

● Savings Center to find discounts on name- brand, everyday and luxury items.

● Learning Center to access lessons to improve your mental and physical health; and

relationships at work and at home.

● Relocation Center to get inside information on a community. Lists the schools, hospitals and places of worship near you. Provides statistics on crime rates, cost and types of housing, age and more.

Filing and Processing of Claims

Employees are not required to file a claim for services provided through the EAP. Call APS Healthcare at 1-866-271-4718 at any time to access services. If additional sessions beyond the three EAP sessions are needed, the EAP counselor may make a referral to a resource such as a local behavioral health care or medical provider. If the employee or immediate family member elects to use those resources, the resulting fees and co- payments, if any, would be the responsibility of the employee or immediate family member.

Exclusions

The following services are specifically excluded from the Scope of Services provided under this plan.

● Services not listed as EAP General Program Services.

● Fees incurred by any employee or family member at agencies other than APS or with APS contracted providers if a referral is not obtained from APS in advance of the initial session are not included in the EAP coverage and are the full responsibility of the employee or eligible family member.

● Biofeedback and hypnotherapy.

● Services required by court order, or as a

condition of parole or probation, not, however, to the exclusion of services to which the

Member would otherwise be entitled. ● Services for remedial education including

evaluation or medical treatment of learning disabilities or minimal brain dysfunction; developmental and learning disorders;

behavioral training; or cognitive rehabilitation. ● Medical treatment or diagnostic testing related

to learning disabilities, developmental delays, or educational testing or training.

● Services received from a non-network Provider, unless pre-approved by APS.

● Psychological testing. (psychological testing is not necessary to determine an appropriate referral to a Network Provider to receive Covered Services, or alternatively, to determine appropriate referrals to community resources for non-covered services)

● Sleep therapy.

● Medical treatment of congenital and/or organic disorders associated with permanent brain dysfunction, including without limitation, organic brain disease, Alzheimer’s disease and autism.

● IQ testing. (IQ testing is not necessary to determine an appropriate referral to a Plan Provider to receive Covered Services, or

alternatively, to determine appropriate referral to community resources for non-covered services.)

● Medical treatment for chronic pain.

experimental, investigational or unproven. ● Medical treatment of any kind.

Informal Member Problem Resolution under the EAP Plan

A member may call APS at any time via the

dedicated toll free number 1-866-271-4718 to seek resolution to a problem.

Your Grievance and Appeal Rights If you disagree with APS’s decision about your services, you have the right to appeal. You may appeal if you believe that the Plan has not paid a bill, has paid a bill incorrectly, or is stopping care you believe you still need.

You may also file a quality of care or general complaint. Please include as much information as possible including the date of the incident, the names of the individual involved, and the specific circumstances.

You must file your grievance or appeal within 30 days of the date of service. To the extent possible, complaints filed will be resolved within 30 days. If the matter is still unresolved following the appeal process you may submit the matter to arbitration conducted pursuant to arbitration rules of the American Arbitration Association

Written grievances or appeals should be sent to: APS Healthcare

Att: EAP Complaint and Appeal 21 Governors Court, Suite 100 Windsor Mill, MD 21244

You may file a grievance by phone by calling the EAP dedicated toll free number 866-271-4718 for Providence Health and Services.

You may fax your grievance or appeal to: 1-301-563-7332

When coverage ends

Your coverage ends as of the earliest of the following events:

● The last day of the month in which your dependent no longer qualifies as an eligible dependent.

● The date Providence terminates the agreement.

Leave of Absence

Contact the HR Service Center for information about continuing your EAP coverage while on a leave of absence.

Conversion of Coverage

You cannot convert coverage under the EAP to an individual policy.

Optional Continuation of Coverage (COBRA)

Federal Law (COBRA) requires that you and your dependents are offered continued EAP coverage if the coverage would otherwise end due to one of the following “qualifying event”:

● Termination of your employment with Providence Health & Services for any reason except gross misconduct. Coverage may be continued for you and your eligible dependents.

● Your death. Coverage may be continued for your eligible dependents.

● Divorce or legal separation from your spouse. Coverage may be continued for the spouse and your eligible dependents.

● Your entitlement to Medicare. Coverage may be continued for your eligible dependents. ● Loss of eligibility by a covered dependent

child because the child no longer qualifies as a dependent. Coverage may be continued for that child.

Individuals who are eligible to continue coverage under the EAP benefit due to the above COBRA provisions are called Qualified Beneficiaries. See page 5-10 for more information on COBRA continuation of coverage.

Providence Health & Services